According to some estimates, around 70 percent of women in West Africa use skin lightening creams, despite a growing body of evidence that these products can cause a raft of often devastating illnesses, from blotchy skin to liver and kidney failure and skin cancer.

Skin lighteners containing potentially harmful ingredients are ubiquitous in many parts of Africa, and Malawi is no exception. Even though it is illegal to sell many types of skin lighteners without a doctor’s prescription, the trade is booming. Especially popular are a dozen or more products containing corticosteroids, a synthetic drug used to reduce inflammation and allergic reactions. The substance also has the property of “lightening” the skin by removing melanin, the body’s natural sunblock.

These products may be locally produced or come from the factories of multinational cosmetics firms like Nivea, which drew heavy flak in West Africa for flogging a product holding out the promise of “visibly fairer skin”.

Such products are widely sold over the counter in Malawi, although they are regulated medicines which should only be available with a prescription from a skin specialist. The import or wholesale/retail sale of such medicines over the counter are serious offenses, but the 1988 law governing the trade is outdated and the penalties for infringements are too lenient, activists say.

Why are legal and illicit skin lighteners such big sellers across Africa and in South Asia, the Caribbean and elsewhere? Some point to the influence of Hollywood and Bollywood, whose movies strongly feature lighter-skinned women; others blame the lingering effects of colonial rule. But all agree that social pressures, added to ignorance of the risks, is a huge factor in keeping these products on the market.

Several African countries, including South Africa, have regulated or banned the use of skin lighteners with active ingredients like hydroquinone – mainly used as a photo developer – and mercury. Others are running awareness campaigns. Yet the trade continues.

This story will look at how and why such banned products continue to enter Malawi. A crucial question is whether women in Malawi are aware of the risks associated with continued use of such products. I will also talk to cancer and skin specialists and some women who regularly use some of these products.